Get documents about "New Document
Description
New Document
Document Sample
Fo o d Po v e r t y a n d H e a l t h
Food Poverty and Health
Briefing Statement
Introduction
In the UK, the poorer people are, the worse their diet, and the more
diet-related diseases they suffer from. This is food poverty.1 Poor diet
is a risk factor for the UK’s major killers of cancer, coronary heart
disease (CHD) and diabetes. Yet it is only in the past few years that the
immense contribution it makes to poor health has been quantified:
poor diet is related to 30% of life years lost in early death and
disability.1
Inequalities in people’s diets can result in inequalities in people’s
health. Those on low incomes suffer from poor diets, as evidenced by
lower fruit and vegetable intakes, and a higher prevalence of dental
caries among children. They are also disproportionately affected by the
major killer diseases. It is estimated that as many as 10 million people
in the UK live in poverty, including nearly three million children.2
Tackling food poverty is recognised as key to achieving government
targets on reducing inequalities and priority health areas including
cancer, CHD and older people and children. However, action needs to
be more than health professionals giving advice to individuals. It must
change the ‘food environment’ – that is, accessibility, affordability,
culture – in which people live. Public health professionals are ideally
placed to take the lead on this – through developing local strategies
and programmes to remove the barriers to healthy eating and thus
improve the nutrition of people living in food poverty.
Evidence
The Department of Health (England) recognises food poverty as “the
inability to afford, or to have access to, food to make up a healthy
diet.” 3
Faculty of Public Health Briefing Statement
Food Poverty and Health 2
Food poverty and effects on health shift towards the recommended balanced diet. Key
Poor diet is a major health risk. It contributes to: benefits include:
■ almost 50% of CHD deaths4 ■ lowering cholesterol levels by just 10% in the UK
■ 33% of all cancer deaths5 would prevent approximately 25,000 deaths
every year.10 This could easily be achieved
■ increased falls and fractures in older people6
through a reduction in saturated fat intakes
■ low birthweight and increased childhood
■ consuming fruit and vegetables has a strong
morbidity and mortality7
protective effect against stroke11
■ increased dental caries in children.8
■ reducing salt (sodium) intake decreases the risk
of hypertension (persistent high blood pressure)
There is also growing evidence to support the link
and therefore risks in cardiovascular diseases
between poor diets and anti-social behaviour. In a
such as CHD/stroke12
placebo-controlled study in men’s prison, vitamin,
■ 0.8mg of folic acid per day reduces serum
mineral and essential fatty acid supplements were
homocysteine by 3mmol, leading to a 16%
associated with a decrease of 37% in serious reduction in CHD and a 24% reduction in
incidents.9 stroke13
A poor diet is characterised by excessive intakes of ■ about 40% of endometrial cancer, and 10% of
saturated fat, salt or sugar, and an insufficient breast and colon cancers would be avoided by
consumption of fruit and vegetable, and dietary maintaining a healthy weight of a BMI of under
fibre.1 25kg/m2 14
■ increased dietary fibre is associated with a
Those who are most likely to experience food decreased risk of colorectal and pancreatic
poverty are:1 cancer15
■ people living on low incomes or who are ■ childhood fruit consumption may have a long
unemployed term protective effect on cancer risk in adults.16
■ households with dependent children
The Nutrition and Food Poverty toolkit provides
■ older people
comprehensive advice on what constitutes a healthy
■ people with disabilities
diet.1
■ members of black and minority ethnic
communities
Food poverty and inequalities
Food poverty results primarily from inequalities, of
Modern Malnutrition
diet, diseases related to poor diet, socioeconomic
Diets high in fat, sugar and salt can result in
status, geographical region and ethnicity.
overweight and obesity – particularly when a
person’s intake from food and drink exceeds the
Inequalities in diet
energy they use. A poor diet which results in ■ People on low incomes eat more processed foods
overweight/obesity is known as ‘modern which are much higher in saturated fats and
malnutrition’. A significant proportion of the salt.7 They also eat less variety of foods.17 This is
population is failing to meet current recommended related to economies of scale and fear of
dietary requirements. For example, in England:1 potential waste.
■ People living on state benefits eat less fruit and
■ children and adults eat 50% more saturated fat vegetables, less fish and less high-fibre
than the recommended level breakfast cereals.18
■ children eat only one quarter, and adults only ■ People in the UK living in households without an
half the recommended levels of fruit and earner consume more total calories, and
vegetables considerably more fat, salt and non-milk
■ children eat 50% more sugar than the extrinsic sugars than those living in households
recommended level. with one or more earners.19
Modern malnutrition is more common in people from Inequalities in diet-related diseases
lower socioeconomic groups.1 Socioeconomic differences account for 5,000 deaths
a year in men aged under 65 years of age.7 In all age
The benefits of healthy eating groups, people living on a low income have higher
Significant health benefits can be achieved at both rates of diet-related diseases than other people.
the population and individual level by enabling a
Faculty of Public Health Briefing Statement
Food Poverty and Health 3
■ In men, 58% more manual workers die ■ Food labelling can be difficult to interpret and
prematurely from CHD than non-manual even misleading, for example a fatty food which
workers.20 claims to have no cholesterol is still a fatty food.
■ The prevalence of obesity among women in ■ Food marketing – 99% of food and drink
social class V is twice that of women in social advertised to children during Saturday morning
class I.21 children’s television programming were high in
■ Diabetes is one and a half times more likely to fat or sugar or salt.
develop in people in the most deprived 20% of
the population compared with the general Policy Context
population.22
There are a number of government health policies
■ Babies with fathers in social classes IV and V
have a birthweight on average 130g lower than designed to address the issue of food poverty, both
babies with fathers in social classes I and II.7 directly and indirectly. The Nutrition and Food
■ In women, the premature death rate from CHD Poverty Toolkit1 gives details of relevant policies and
is more than double in manual workers, strategies. However, key drivers include:
compared with non-manual workers.23
UK: The Healthy Start scheme aims to improve
■ People from lower socioeconomic backgrounds
are less likely to survive some cancers. For nutrition, particularly for pregnant women, mothers
example, the difference in breast cancer and and young children, through making a wider choice
colon cancer five-year survival rates between of foods available, including fruit and vegetables.
the most deprived and the most affluent are 7% Healthy Living Centre Programmes target the most
and 4% less, respectively.24
deprived areas and groups. They seek to address
the wider determinants of health including the social
Geographical inequalities
and economic aspects of deprivation such as social
There are significant regional variations in diet-
exclusion, and poor service access.
related disease in the UK. For example, there is a
steady rise in obesity rates in men, the further north Sure Start is a UK-wide programme which aims to
they live.1 deliver the best possible start in life to children in
deprived communities. It offers opportunities for
Ethnicity early interventions to prevent poor health in later
There are differences in diet-related disease in life. Responsibility for delivering Sure Start in
different ethnic groups. For example, stroke Scotland, Wales and Northern Ireland rests with the
mortality rates are around 50% higher in South devolved administrations.
Asian and black Caribbean men and women than in
the general population.1 England and Wales: The 5 A DAY programme is part
of prevention strategies to reduce deaths from
Barriers to healthy eating cancer and CHD. It includes the School Fruit and
In order to eradicate inequalities in nutrition, the Vegetable Scheme, and working with industry to
main barriers to eating healthily must be removed. improve access to fruit and vegetables. Some
These include:1 aspects of the programme do not apply in Wales.
■ Low income and debt making healthier foods England: Choosing a Better Diet: a Food and Health
(which are generally more expensive) such as Action Plan outlines government action to improve
fresh fruit and vegetables, less affordable. diet. It focuses on providing better information, and
■ Poor accessibility to affordable healthy foods increased choice and access to healthier food. It also
– linked to the closure of shops in deprived areas aims to reduce the prevalence of diet-related
(leading to increased cost, poor quality and disease, obesity and improve the nutritional balance
choice in remaining local shops), and to the
of the average diet. Choosing Health: Making
development of out-of-town supermarkets which
Healthy Choices Easier is the overarching public
may have poor public transport links.
health white paper which looks at the wider
■ Factors in food production and the food chain,
determinants and barriers to choosing a healthy
such as the nutrient content of easily available,
lifestyle, including inequalities, physical activity etc.
cheap, processed foods which can be high in fat,
sugar or salt. The Department of Health Public Service Agreement
■ Poor literacy and numeracy skills are barriers (PSA) sets objectives to substantially reduce the
to information on maintaining a healthy diet, mortality rates from the major killer diseases as well as
household budget management and halt the year-on-year rise in obesity among children.
employment.
Faculty of Public Health Briefing Statement
Food Poverty and Health 4
Tackling Health Inequalities: A Programme for
Action sets out the government’s strategy to deliver The Faculty of Public Health has produced, in
the PSA health inequalities targets, focusing on low- association with the National Heart Forum, the
income and minority ethnic groups who are Government Office for the North West, the
disproportionately affected by the major diseases. Government of the West Midlands and the West
Midlands Public Health Observatory, Nutrition and
Scotland: Eating for Health – Meeting the Challenge Food Poverty. A toolkit for those involved in
integrates the Scottish Executive’s food policy and developing or implementing a local nutrition
key partner strategies to promote healthy eating and food poverty strategy.1 The toolkit is
and achieve Scottish Dietary Targets. designed to help professionals tackle food poverty
at local level. It outlines the barriers to healthy
The Scottish Community Diet Project seeks to
eating and the role poor diet plays in the major
improve Scotland’s diet and health through
killer diseases. Nutrition and Food Poverty forms
supporting low-income communities. It offers a
part of a wider campaign of work, in partnership
grant scheme for community initiatives to improve
with key health organisations, aimed at promoting
diet and health.
healthier lifestyles to reduce disease burden
through the production of toolkits on the wider
Wales: Food and Well Being – Reducing Inequalities
determinants of health including hypertension,
through a Nutrition Strategy for Wales outlines key
physical activity, obesity and fuel poverty.
actions to improve diet in Wales. Recommendations
include increasing fruit and vegetable intake, as well
as ensuring national and local policies are in place to Recommendations
remove barriers to healthy eating.
The Community Food Initiative provides a limited Improving nutrition and eradicating food poverty are
number of grants from the Welsh Assembly essential to national strategies concerned with
Government to increase healthy eating, particularly tackling inequalities and healthy priorities, including
amongst the most disadvantaged groups. the major diseases of cancer, CHD and stroke.
Primary care organisations and local authorities, in
Northern Ireland: The Health Promoting Schools association with other local organisations, should
Initiative envisages the school as a setting which develop nutrition and food poverty strategies and
can offer considerable opportunities for tackling programmes to reduce the barriers to healthy
inequalities in health and contribute to a child’s eating.
whole development. The Fresh Fruit in Schools pilot
■ Establish a local ‘food poverty partnership’ with
aims to provide access to fruit for P1 and P2 children
key organisations including health services, local
within pilot areas. It also aims to promote
authorities and voluntary organisations, for
awareness and uptake of healthy eating. example, to develop a local food poverty
Fit Futures: Focus on Food, Activity and Young strategy. The Nutrition and Food Poverty Toolkit1
People is an initiative to develop ideas for improving gives comprehensive advice on how to do this.
the health and well-being of children and young ■ Work with local public sector service providers,
people through encouraging and supporting healthy such as schools, hospitals, prisons etc, to
and active lifestyles. develop procurement policies which ensure that
good quality, healthy food is sourced locally
Investing for Health is a framework for improving wherever possible.
the health and well-being of people in Northern
■ Work with the local community to understand
Ireland. It includes targets to reduce the gap in life their views on priorities, barriers and
expectancy between the most affluent and the most opportunities – through community meetings,
deprived communities. surveys and promote healthy eating.
■ Undertake a food mapping survey to identify
International: The First Action Plan for Food and those shops where healthy food is affordable
Nutrition Policy. WHO European Region 2000-2005 and accessible.
focuses on the need to develop policies on nutrition ■ Develop local programmes to promote healthy
that promote good health, and which contribute to eating and physical activity. Initiatives such as
socioeconomic development as well as sustainable cooking clubs, for example, should be created to
environments. encourage and develop cooking skills, and
increase nutritional knowledge. Integrate food
Details of policies and initiatives can be found in
poverty with existing local programmes and
Publications and Useful Organisations p.6.
strategies, such as local obesity strategies.
Faculty of Public Health Briefing Statement
Food Poverty and Health 5
■ Produce local information to explain the ● improving access to affordable, good quality
importance of healthy diet and what constitutes foods for those without cars, for example
a healthy diet, as well as listing local suppliers through improving public transport links and
where good quality affordable food is available. supporting shopping-carrying schemes, or
■ Work to eliminate the barriers to healthy eating community delivery schemes from retailers.
through: This can be considered in the planning and
regeneration of town centres and residential
● providing help with money matters eg. areas
through a local authority anti-poverty unit, ● improving nutrition through schools, for
and ensuring benefit entitlements are example by providing breakfast before
claimed school, to help children who are not given
● providing better housing conditions to tackle breakfast at home, and offering healthier
lack of cooking equipment or storage to school meals.
enable bulk buying
References 7 Acheson D. 1998. evidence of causality from a
Independent inquiry into meta-analysis. BMJ; 325:
1 Press V on behalf of the inequalities in health. London: 1202-06
National Heart Forum, Faculty The Stationery Office
14 Bianchi F, Kaaks R, Vainio H.
of Public Health, Government
8 James WPT et al. 1997. Socio- 2002. Overweight, obesity
Office for the North West,
economic determinants of and cancer risk. The Lancet
Government Office for the
health: the contribution of Oncology; 3(9): 565
North East, and West Midlands
nutrition to inequalities in
Public Health Observatory. 15 Department of Health. 1998.
health. BMJ; 314: 1545-55
2004. Nutrition and food Nutritional aspects of the
poverty: a toolkit for those 9 Gesch CB et al. 2002. development of cancer: report
involved in developing or Influence of supplementary of the working group on diet
implementing a local nutrition vitamins, minerals and and cancer of the Committee
and food poverty strategy. essential fatty acids on the on the Medical Aspects of
London: National Heart Forum antisocial behaviour of young Food and Nutrition Policy.
adults. British Journal of London: HMSO
2 National Statistics. 2005. First
Psychiatry; 181:22-28
release. Households below 16 Maynard M et al. 2003. Fruit,
average income statistics. 10 Unal B, Critchley JA, Capewell vegetables and antioxidants
London: Department for Work S. 2004. Explaining the in childhood and risk of adult
and Pensions decline in coronary heart cancer: the Boyd Orr cohort
disease mortality in England study. BMJ; 316: 499-50417
3 Department of Health. 2005.
and Wales between 1981 and
Choosing a better diet: a food 17 Dowler E, Calvert C. 1995.
2000. Circulation 109: 1101-
and health action plan. Nutrition and diet in lone
1107
London: Department of Health parent families in London.
11 Ness AR, Powles JW. 1997. London: Family Policy Studies
4 Yusuf S, Hawken S, Ounpuu S
Fruit and vegetables, and Centre
et al. 2004. Effect of
cardiovascular disease: a
potentially modifiable risk 18 Food Standards Agency. 2002.
review. International Journal of
factors associated with National Diet and Nutrition
Epidemiology; 26(1): 1-13
myocardial infarction in 52 Survey: Adults Aged 16-64.
countries (the INTERHEART 12 Maryon-Davis A, Press V on Volume 1. London: Food
study): case-control study. behalf of the Faculty of Public Standards Agency
Lancet; 364: 937-52 Health and National Heart
19 Department for Environment,
Forum. 2005. Easing the
5 Doll R, Peto R. 1981. The Food and Rural Affairs. 2001.
pressure: tackling
causes of cancer: quantitative National Food Survey 2000.
hypertension. A toolkit for
estimates of avoidable risks London: The Stationery Office
developing a local strategy to
in cancer in the United States
tackle high blood pressure. 20 Peterson S, Rayner R. 2003.
today. Journal of the National
London: Faculty of Public Coronary heart disease
Cancer Institute; 66:1191-208
Health statistics. British Heart
6 Vellas B et al. 1986. Foundation Statistics
13 Wald DS, Law M, Mavis JK.
Malnutrition and falls. The Database 2003. London:
2002. Homocysteine and
Lancet; 336: 1447 British Heart Foundation
cardiovascular disease:
Faculty of Public Health Briefing Statement
Food Poverty and Health 6
21 Joint Health Surveys Unit. Useful Organisations Acknowledgments
1999. Health Survey for
England 1998. London: The 5 A DAY Programme Authors
Stationery Office w: www.5aday.nhs.uk
Modi Mwatsama
22 Department of Health. 2002. British Dietetic Association Food and Health Programme
National Service Framework w: www.bda.uk.com Manager
for Diabetes. London: Heart of Mersey
Department of Health British Heart Foundation
Heart information line: Lindsey Stewart
23 Joint Health Surveys Unit. 08450 70 80 70 Faculty of Public Health
2003. Health Survey for w: www.bhf.org.uk
England 2001. London: The Series Editor
Stationery Office British Nutrition Foundation Lindsey Stewart
w: www.nutrition.org.uk
24 Department of Health. 2000. Produced by
The NHS Cancer Plan. London: Child Poverty Action Group Faculty of Public Health
Department of Health w: www.cpag.org.uk 4 St Andrew’s Place
London NW1 4LB
Community Food Initiative
Publications t: 020 7935 3115
w: www.cmo.wales.gov.uk
e: healthpolicy@fph.org.uk
Choosing a Better Diet: a Food Food Vision – Improving w: www.fph.org.uk
and Health Action Plan (2005) Community Health and
Choosing Health: Making Healthy Registered charity no: 263894
Well-being
Choices Easier (2004) ISBN: 1-900273-20-9
Joint resource from the Food
Public Service Agreement (2002) Standards Agency, Local Publication date: May 2005
Tackling Health Inequalities. A Government Association, Local
Programme for Action (2003) Authorities Coordinators of
The information provided in this statement is correct
Department of Health Regulatory Services
at the time of going to press.
w: www.dh.gov.uk w: www.foodvision.gov.uk Design and print: www.fosterandlisle.co.uk
Eating for Health – Meeting the Food Standards Agency
Challenge (2004) w: www.food.gov.uk
Scottish Executive
w: www.scotland.gov.uk Fresh Fruit in Schools
Healthy Promoting Schools
First Action Plan for Food and Initiative
Nutrition Policy. WHO European w: www.investingforhealthni
Region 2000-2005 .gov.uk
World Health Organisation Summary
w: www.euro.who.int Healthy Living Centre
Programmes This briefing gives an overview
Fit Futures: Focus on Food, w: www.nof.org.uk of the inequalities related to
Activity and Young People (2004)
Investing for Health Healthy Start food poverty, and its
w: www.investingforhealthni.gov.uk w: www.dh.gov.uk consequences including
diet-related disease, as well as
Food and Well Being – Reducing Local Government Association
w: www.lga.gov.uk outlines the benefits and
Inequalities through a Nutrition
Strategy for Wales (2003) barriers to eating healthily.
National Consumer Council
Welsh Assembly Government The statement also makes
www.ncc.org.uk
Available from the Food Standards important recommendations
Agency National Heart Forum for action that can be
w: www.food.gov.uk w: www.heartforum.org.uk
implemented at local level.
Investing for Health (2003) Scottish Community Diet Project It is not intended as an
Department of Health, Social w: www.dietproject.org.uk exhaustive resource but as a
Services and Public Safety signpost to the key evidence,
Sure Start
w: www.dhsspsni.gov.uk
w: www.surestart.gov.uk publications and organisations
as a next step to
Sustain
w: www.sustainweb.org understanding and tackling
this important public health
issue.
